Impella RP Versus Pharmacologic Vasoactive Treatment in Profound Cardiogenic Shock due to Right Ventricular Failure

• Published in: Journal of cardiovascular translational research Vol. 14; no. 6; pp. 1021 - 1029
• Main Authors: Josiassen, Jakob, Helgestad, Ole K. L., Udesen, Nanna L. J., Banke, Ann, Frederiksen, Peter H., Schmidt, Henrik, Jensen, Lisette O., Hassager, Christian, Møller, Jacob E., Ravn, Hanne B.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2021
• Subjects: Animals; Biomedical Engineering and Bioengineering; Biomedicine; Cardiac Output; Cardiology; Disease Models, Animal; Heart-Assist Devices; Hemodynamics; Human Genetics; Medicine; Medicine & Public Health; Norepinephrine - pharmacology; Original Article; Oxygen Saturation; Shock, Cardiogenic - etiology; Shock, Cardiogenic - therapy; Swine; Ventricular Dysfunction, Right - complications; Translational science; Vasopressor; Impella RP; Ventricular unloading; Hemodynamics; Cardiogenic shock
• ISSN: 1937-5387; 1937-5395
• DOI: 10.1007/s12265-021-10131-x

The aim was to translationally compare a pharmacologic strategy versus treatment with the Impella RP in profound RV cardiogenic shock (CS). The pigs were allocated to either vasoactive therapy with norepinephrine (0.10 μg/kg/min) for the first 30 min, supplemented by an infusion of milrinone (0.4 μg/kg/min) for additional 150 min, or treatment with the Impella RP device for 180 min. Total RV workload (Pressure-volume-area × heart rate*10
3
(mmHg/min)) remained unaffected upon treatment with the Impella RP and increased in the vasoactive group (CS 179[147;228] to norepinephrine 268[247;306](
p
= 0.002 compared to Impella RP) and norepinephrine + milrinone 366[329;422] (
p
= 0.002 compared to Impella RP). A trend towards higher venous cerebral oxygen saturation was observed with norepinephrine than Impella RP (Impella RP 51[47;61]% vs norepinephrine 62[57;71]%;
p
= 0.07), which became significantly higher with the addition of milrinone (Impella RP 45[32;63]% vs norepinephrine + milrinone 73[66;81]%;
p
= 0.002). The Impella RP unloaded the failing RV. In contrast, vasoactive treatment led to enhanced cerebral venous oxygen saturation.